The Case of the Perfect Performer

Junior Moleray rubbed his large hand against the jet-black stubble on his square jaw. His feet were on his desk, and a dead pint of Old Croup Whisky was in the dumpster. It was quiet in the Moleray detective agency. Too quiet.

Moleray specialized in medical insurance fraud. It had been a week since he had solved the last case. A cagey bird had been collecting disability payments on five different accounts. Moleray caught up with him on a double black diamond run at Jackson Hole. Case solved. It had been too easy.

Junior thought about how he’d gotten into the detective racket. It was an improbably sad story. He’d been a detective on the Philadelphia police force and quit to become a medical student—the second doctor in the family.

His older brother, Maurie, had just finished an internal medicine residency and had signed with a clinic in Punxatawney—an outpatient internal medicine and pain clinic. Things were great for Maurie those the first two weeks. He was still getting his feet wet when his boss, Dr. Rock, went on vacation and disappeared while climbing in Malta. Shortly thereafter Rock’s widow showed up at the clinic with legal papers in hand. She offered to sell the entire practice for $10,000 cash just to be done with it. It was a beautiful office and a busy practice. Dr. Rock’s misfortune was Maurie’s stroke of luck. The deal was closed in 24 hours.

“Come on in, honey” was the last thing he heard as he stepped into the room. He woke up hours later in an empty room with an occipital goose egg.

A week later, moving men came for the furniture (it was all rented and payment was overdue). Then the building manager evicted Maurie because the rent was also unpaid. Within two weeks he was accused of Medicare and Medicaid fraud and prescription peddling and named as a codefendant on six separate malpractice cases. The malpractice premiums hadn’t been paid in months.

Mrs. Rock was nowhere to be found. Maurie had been framed. His license was suspended. His debt was magnificent. His career in tatters.

Junior got to his brother’s house just in time. He found Maurie knotting ties together into a noose.

Junior quit medical school to track down the wife. After months, he found Mrs. Rock living in a shotgun shack in St. Bernard Parish, La. It didn’t look like the home of a rich widow. When he saw Mrs. Rock, his draw dropped. She was a tall drink of water, and he wanted to be the straw. Later he couldn’t remember what her face looked like. She invited him in.

“Come on in, honey” was the last thing he heard as he stepped into the room. He woke up hours later in an empty room with an occipital goose egg. There was nothing left except some half filled out forms in a precise handwriting. It was a cold trail that he swore he’d pick up again one day.

The ringing of the phone was a welcome relief.

“Moleray, it’s your dime,” Junior barked into the receiver.

“Hey Mole,” came an annoyingly familiar voice on the phone, “I got a hot one for you.”

It was Benny “the Weasel” Rabinowitz from the Mutual International Reinsurance Corporation.

“We’ve got a hospital that just submitted some numbers that are hard to believe, perfect numbers,” said Rabinowitz. “Unless we figure out their scam, we are going to have to fork over a cool million in pay-for-performance bonus fees. I smell a rat.”

“What’s the matter, Weasel, don’t your handlers at the Mutt want to pay the piper?” Junior retorted. He never trusted these big companies, even if the clients were defrauding them. The companies were none too innocent themselves. He took the case. It beat boredom.

The hospital was a rickety old building on South Main. It didn’t seem like the type of facility that would have perfect utilization numbers, but looks can be deceiving.

The medical records office was in the basement. A grumpy woman directed him to a pile of charts and disappeared. Junior spent the next six hours sitting in the cramped cubicle, sipping lukewarm, weak coffee and marveling at the perfect records. They were all written by the same physician with the perfect handwriting. There was something familiar about the writing, but Junior couldn’t make the connection.

The records were meticulous. Every patient with an MI had been given an ace inhibitor, a beta-blocker, aspirin, and a statin. But every patient was identical; the EKGs identical; the lab values identical—even the vitals were the same. Something was very wrong with these charts. By day’s end Junior was ready to go back to his cheesy motel room and make some phone calls. He had lifted some phone numbers from the charts. (Junior didn’t let a little thing like confidentiality stand in his way.) He tried to call several patients, but every single one of them had a disconnected phone.

The next morning Junior returned to the record room and knocked on the door. There was a different clerk today. A lilting voice said, “Come on in, honey.”

Junior started to get chills up and down his spine. He knew that voice … from somewhere. He felt her brush against his back. The smell of jasmine filled the air as she place a cup of coffee on the desk before him. As he finished off the foul morning brew it came to him. He knew her voice and her handwriting.

He stood quickly and turned toward her, but his head began to swim. Suddenly she was joined by a man whose photo he had seen before. It was Dr. Rock and his “wife.” Junior took a step toward them and then hit the ground, drugged into oblivion.

Fluorescent lights. Movement though a hallway. Junior found himself strapped on a gurney. He heard the orderly talking, maybe to a nurse.

“Is this Mr. Johnson?” asked the nurse. She checked his arm band; the ID was correct.

“He doesn’t say much does he?” the orderly commented.

“He’s going for resection of a huge brain mass,” the nurse replied.

Junior wondered who they were talking about as his stretcher was wheeled into the operating room. He felt the IV go into his hand. They checked his arm band again: “This is Hugo Johnson, birth date Oct. 5, 1957? OK.” They started to put the mask over his face, and Junior summoned all his strength and whispered, “Not me.”

The anesthesiologist shook his head, ”Sorry I know you’re scared but these things happen to everyone. You’ll be fine, Hugo.”

Junior tried again: “Not Hugo.”

The anesthesiologist nodded again, “I know we all feel immortal, but anyone—even you—can get sick.”

The mask came toward Junior again. He knew this was his last chance before his skull was cut open and his brain dissected in a hunt for a tumor that was not there.

Summoning his last reserve of energy, he yelled, “Sentinel event.” Everyone in the room stopped cold.

Junior sat in his office, his feet on his desk, and a newly deceased pint of Old Croup in the dumpster. He looked at his check from the Mutual for $25,000. He was ready for his next case. TH

Jamie Newman, MD, FACP, is the physician editor of The Hospitalist, senior associate consultant, Hospital Internal Medicine, and assistant professor of internal medicine and medical history, Mayo Clinic College of Medicine at the Mayo Clinic College of Medicine, Rochester, Minn.